Clinical Workflow Center, Next Edition!

Four years ago, I began EHR Science as a way to connect with others who shared my interest in EHR systems and computer technology. To that end, the blog has been a great success. The incentive programs brought more interest in EHRs in a few months than I had seen in the previous 10 years combined. Unfortunately, what should have been an opportunity to adopt the best technology to improve care quality and delivery was mangled by MU. Both adoption and dissatisfaction have increased. Critically, over the last six years, we have learned that providing data and supporting clinical work are not automatically the same thing.

There is a call for more usable EHR systems that support clinical workflows, or at a minimum, do not disrupt them. MU, for all the problems it has caused, has had a few positive unintended side effects that will ultimately prove to be valuable to clinical care software design. The warts of current systems have made discussions of usability, workflow, software design, and interoperability, which would have been considered arcane and obscure six years ago, commonplace. These are the very topics required to create better systems and move health care forward technologically — I love it!!!

As times and topics have changed, so have the posts on EHR Science. The value of workflow analysis and modeling for patient safety, decision support, care quality and other important issues is now widely recognized. I think it’s safe to say that everyone realizes there is more to clinical software than a graphical front-end and a relational database. It is increasingly obvious that workflow models and workflow support are required to design and build usable, safe clinical software.

Last spring, I began the final phase of my workflow education with a dive into the human factors literature. That was an eye-opening experience because it revealed yet another approach to clinical workflow that needed to be folded into standard software design thinking. Just as importantly, human factors research has much to say about safety and errors as well. Unfortunately, there is no standard way of representing or even discussing workflows across all groups of professionals who have shown an interest in clinical software design (see Workflow with Friends). This has to end.

Clinical care is replete with hard problems that require new analytical methods and tools to explore causes and solutions. I now see clinical workflow analysis and modeling as essential tools not only for designing software, but also understanding clinical care. Clinical software design has to evolve from a focus primarily on data and terminology to include clinical processes. As much effort has to be put into the abstraction of clinical concepts for computational use as is put into database schema design—possibly even more. The growing body of research on usability problems has strengthened this conviction. Better user interfaces start deep inside the software, not at the surface (see Liberating the EHR User Interface-Parts I & II).

Epiphanies have a way of changing one’s behavior. In my case, this means more effort will be devoted to promoting all facets of clinical workflow—education, mathematics, research, tools, methods, and technology. The same holds for clinical software design. The first fruits of these efforts begin today in the form of a revamped Clinical Workflow Center. A major goal of CWC is providing a place where everyone interested in workflow as it pertains to clinical care and clinical software can interact and share ideas—perhaps even form collaborations. In addition, more emphasis will be placed on workflow technology applications. All are welcome to submit articles, product announcements, event information, or participate in the forum. A future site is planned that will focus on clinical software design for mobile devices.

This is the most excited I have been about healthcare computing since finishing my informatics fellowship. I have been waiting a long time for this confluence of factors to occur—fast, mobile computers with multimodal communications ability, powerful software development tools, data storage choices beyond two-dimensional tables, and a means to describe clinical processes to an arbitrary level of detail visually and mathematically. Life is GOOD!!!!

EHR Science will still address the same range of topics. However, since I try to limit the length of posts, it is not ideal for in-depth treatments. As it remains my personal soapbox, outside content is still verboten. Creating specialized sites allows for in-depth support of topics in environments designed especially for them. For example, I may serialize chapters of the planned clinical workflow book on CWC or offer webinars. Please take a moment to visit Clinical Workflow Center, and let me know what you think.

Jerome,
Tried to register for the Clinical Workflow Center. Kept on telling me I didn’t have enough “symbols”. Does this mean punctuation marks, emojis, musical instruments (although I think that is with a C). That was certainly my 1st workflow problem. I had previously outlined my clinician workflow on our implementation list. I was comforted that many other clinicians agreed theirs was similar. This did not address the workflows of other members of the care team, but certainly the “others” dovetails with what I did and adjustments to their workflow could potentially streamline things I do. It is often hard for me to think of this using abstract modeling concepts, but it is easier for me to describe it for specific clinical interactions. Anyway, the first step is registering.
John D

Hi John, sorry for your troubles. This is the first time anyone has ever asked this question for any site I have had. Passwords require standard ascii characters of the keyboard. On a standard keyboard, the symbols are characters other than numbers or letters.

One reason for the difficulty in modeling clinical interactions is that there is no defined set of concepts/representations specific to clinical care. For the last 18 months, I have been working on such a set of concepts with objective definitions and corresponding representations. My work builds on the last twenty years of workflow research, which is based on graph theory.

The article that appears on CWC, “Clinical Workflow Analysis–More Useful than You Thought,” is actually most of the first chapter of a book on clinical workflow analysis/modeling that I began working on this summer. I hope to introduce the complete set of concepts and representations in that book.

Love the new site! Bravo, and I think this is a big step forward in advancing the understanding of clinical workflows. You might consider reaching out to the ONC who I know is currently working on a “Workflow Summit”. Love to be part of the choir. 🙂

Thanks for the support! This might sound far-fetched, but I think using formal WF analysis methods (mathematics-based) will be a huge boon to every aspect of HIT and clinical care. Sort of like what calculus did for physics…